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Building A Insp�ctions 763-572-3604 763-502-4977 FAX DATE i/ I G/ I 1 SITE ADDRESS � ` THIS APPLICANT IS: PROPERTY OWNER/ TENANT CONTRACTOR SUBMIT A COPY OF YOUR STATE LICENSE AND CERTIFICATE OF INSURANCE PROPERTY TYPE PERMIT TYPE TYPE OF WORK: BUILDING RESIDENTIAL APPLICATION CITY OF FRIDLEY EFFECTIVE 1-i-2011 E-MA1L ADDRESS 1�� ❑ OWNER �CONTRACTOR ADDRESS: ���� (t I S� � CITY PHONE: �� Zj `j'j � O I V Z Permit No.:� Received By: Date��l:� 1 � C� ��, STATE MVLZiP_?5�132 STATE LICENSE.�J �(,Q y I S� �P LEAD CERT NUMBER \ ADDRESS: �� 1� 0.�1.�. v' %R� CTTY��STATE %'t/�LIP�� PHONE (n I Z in �P% [ �¢ � FAX �'SINGLE FAMILY/NEW CONSTRUCTION SIZE � TWO FAMILY/NEW CONSTRUCTION STORIES ❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS R[�A�EMENT F[NiSH ❑ ROOF ❑ DRAIN T[LE ,I�DECK ❑ SIDING � OTHER ❑ SWIMMING POOL ❑ NEW HOME CONSTRUCTION 6a' ADDITION ❑ MAINTENANCE/REPAIR ❑ REMODELING DESCRIBE WORK BE1NG DONE: SIZE OF IMPROVEMENT I i!t 5C ROOFING NUMBER OF SQUARES GARAGES PROPOSED SIZE: PROPOSED HEIGHT: SIDING ❑ Vinyl ❑ Aluminum ❑ Other iCD i� LENGTH �% � W1DTH � 1�_ HEIGHT G'r � SQ FT WINDOWS IN EXISTING OPENINGS ❑Yes ❑No OR FOR NEW OPENINGS-DESCRIBE SIZE OF OPENING CHANGES & 7YPE OF WINDOW TO BE INSTALLED ❑ HOUSE ONLY ❑ HOUSE & GARAGE ❑ ATTACHED GARAGE ❑ DETACHED GARAGE ❑Soffit ❑Trim ������D 0 Fascia LOCATION OF WTNDOWS NUMBER OF BASEMENT REMODELING SUBMIT: I . Existing Floor Plan 2. Proposed floor plan 3. List of strucLUral members to be used FOR NEW CONSTRUCTION INCLUDING DECKS, ADDITIONS. & PORCHES SUBMIT: l. Site Plan/Survey showing the existing structures and proposed project. 2. Two sets of construction pfans 3. Energy Calculations FOR WINDOWS — PROVIDE U-VALUE AND MANUFACTURE STICKER ON WINDOW. ALL FEES ARE BASED ON VALUATION, tNCLUDING THE COST OF LABOR AND MATERIALS: (U}� IANG THE 1997 U.B.0 FEE SCHEDULE) COTAL JOB VALUATION $ �, I l� L.�� OCCUPANCY TYPE Permit Fee Plan Review Fire Surcharge Surcharge License Surcharge SAC Charge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge Total Due $ $ $ $ $ $ $ $ $ i�'� See Back Page for Fee Schedule 65% of Building Permit Fee .001 times the total job valuation .0005 x Permit Valuation Minimum $5.00 $5.00 (State Licensed Residential Contractors) $2230 per SAC Unit (Plans to MWCC for determination) ft+6ft= ftx$25=$ $450 Conservation Plan Review Fee Determined by Engineering Agreement necessary ( ) Non Necessary ( Make checks pavable to: City of Fridley Attach THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED I hereby apply for a building permit and I cknowledge that the information above is complete and accurate; that the work will be in conformance with the ordinances and codes of e Ci f ridley and with the Minnesota Construction Codes; that I understand this is not a permit but only an application for a permit and k' not to start without a permit on site; that the work will be in accordance with the approved plan in the case of all wo k whi h req ' e view and approval of pl�ns. j„j_ �� DATE �/(2/ �( SIGNATURE OF APPLICANT RINT NAME (, �.C.1 � 1�/L APPROVAL iNSPECTOR SIGNATURE - � i � ._� � — , �^�, ........:�. �J , , ...�...... �� .__ �a" � J .-. ,. ...,._._...._._..., � � ....a.._._-..—_-_ ..__._." 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NOt G�IARAN�� � = � - ~v �• • � � � i �1� C1TY OP � ,?►C�t1RACY �F U'�LIT1f °LOd1�:�UW�eA��3.1�I�iA�nument pHlS �NSAU5ING R'NSNOUI!)��VEWFY THES IN ONRMAI j. ^ EfdS c�� �rM� s+'�• Descriptior�� Lot �, 81ock 4� RICE CREEK ESTATES 2ND ADDItIflN�- Anoka County. Minnesota �--�1�RURTANT'— ����rs l�TIFY THE FRIDLEY ENGR. Before digging ca�l f,ocaf uhT�ies. 9lVtS10N REGARDlNG C!1 RB TE�EPH�E � Ef.ECfBtC . C� �}�, (95�9) Oeno-ir.� exist'►r�g etevc��ion. ��M�VAL AfWD REPLACEf��NT ' �QUIR�>� �1Z DRtVEWAY OPENINGS. C9S4,o� Deno�e� �roposed gr�e, � �"� ��', �OWiZ �' �vuntrc� c�urvec�ora _ L'dncl SJNlyiny • Site Plann�ny� ' Civil Engineerinq �. ' `�Av. N. (1 94 at 800ne Av N) n Park, h1N 5�i428 `^w`533 7340 I hcereby r.artify that thi; .is. a. true and c�rr�:ct r�presen�atir�».nf.;a �a�r�rq,y �f Jt�k� h��� the boundaries nf the above'rJ�scrit�d land and of the location uf a�J bwtct�n�, �2� - if 3ny, thei eo��, and all visible eneroachrt�dnts, if dnv, irom cx on s8id lar;d . � .,�,-...., _-.. ._..... � �:' �3x�c>k -- f'uy� As survcyccl by me this _��.��r d�y of _.._.�t.LY3,�..._... .... :�S� ' • ' S �.g� . _.__.__.__-----___���.�G.__��12�_-___._----�.-.- ..��e _ M:i�n. F''E'9. NV-. _.._� ---�-'-- " _' 4d